The stunning expansion of sports wagering following decades of casino expansion certainly gives any rational person reason to pause. 

For most bettors, gambling is an occasional form of entertainment Powerball tickets when the jackpot swells to $1 billion, Super Bowl squares with co-workers, a birthday trip to the casino.

But for other people, the possibility of developing a gambling disorder looms.

To what extent should Americans be worried? 

To gamble is to be human

A nuanced answer begins with the fact that gambling has been popular for a long, long time. 

Evidence of gambling has been found in ancient cultures around the world. Archaeologists have unearthed dice marked with pips, or dots, in Mesopotamia that date back to 1300 B.C. Historians have located records of dice games in Greek and Indian cities before 400 B.C. 

In North America, one Navajo myth tells the story of Noqoìlpi, or the gambler. Informal gambling games and lotteries were common in the American Colonies, including lotteries to fund the Continental Army. 

In the U.S., sports and gambling have long been intertwined. In the decades after the Civil War, pool halls were set up near Western Union stations so gamblers could easily place bets on horses. And sports like baseball and boxing became hugely popular in the 19th century, in part because they attracted action from bettors.

For as long as theres been gambling, there has also been problem gambling.

Several writers in ancient India highlighted the consequences of habitual gambling. Over 150 years ago, Dostoyevsky famously wrote Crime and Punishment to pay off gambling debts. And in the 20th century, sports betting imploded the careers of baseball legends Shoeless Joe Jackson and Pete Rose.

When problems arise

I describe this history because it shows that humans have always seemed to find a way to gamble, whether its legal or not. And, inevitably, some bettors will experience harm or a gambling disorder.

I direct the Institute for Gambling Education and Research, where we focus on the treatment of gambling disorder and gambling problems.

Psychologists have only recently begun to view problem gamblers as a form of addictive behavior, in which gambling urges, tolerance and withdrawal are akin to how substance use disorders unfold. Researchers have found that brain imaging data and symptom patterns of problem gamblers are similar to those of people who are addicted to drugs or alcohol. Gamblers can build a tolerance, meaning that they need to gamble more and bet in higher amounts in order to maintain the same levels of excitement. And attempts to cut back or stop can lead to emotional struggles. 

There are also financial and social ramifications to gambling disorder.

Distress about money is the most frequently cited reason people start questioning whether they have a problem. But other symptoms include damage done to relationships, deterioration in mood and the physical costs of this distress. Problem gamblers often lie about or hide their gambling, which can make it difficult for loved ones to recognize.

The best prevalence research shows that somewhere between 1% and 2% of the U.S. adult population, or 2 to 4 million adults, will experience a gambling disorder in their lifetime. Another 3% to 5%, or 5 to 9 million people, will, at some point in their lives, report a subclinical problem, which means that some gambling disorder symptoms are present but the psychiatric diagnosis is not warranted.

Despite some hand-wringing over the expansion of sports betting, I believe any increase in the rate of problems is likely to be temporary. A review of 30 years of research on the prevalence of problem gambling and gambling disorder reveals a pattern. More gambling availability tends to lead to a spike in the number of people reporting gambling issues in the short term. However, populations tend to adapt over time; the rate of gambling problems decreases accordingly. 

It will be interesting to see whether the same pattern plays out for sports betting. 

Barriers to treatment

My team also operates an outpatient clinic where we treat people with gambling disorder. Our research and therapy sessions have pointed to some encouraging news, along with a few barriers. 

The good news is that treatment, particularly when it includes cognitive behavioral techniques, significantly reduces gambling disorder symptoms and psychological distress. While long-term treatment is recommended, an effective course of treatment is about eight to 10 sessions. 

Yet there are still roadblocks. People are often hesitant to try treatment; those who do frequently drop out. 

People are often unaware they have gambling problems, even when they report having symptoms of problem gambling. We dont exactly know why. The impact, though, is substantial. Only about 10% of individuals with a gambling problem ever seek treatment. As a comparison, the rate of seeking help among those with substance use disorders runs somewhere between 10% and 50%. Its considerably lower than those experiencing depression and anxiety, 70% to 90% of whom will seek treatment.

We also know that gambling disorder is one of the most stigmatized mental health concerns. We find that people tend to blame someone who has developed gambling problems, and view them as dangerous or untrustworthy. By contrast, someone experiencing depression and anxiety is less likely to be blamed for their problems.

The other challenge is the rate at which people discontinue treatment before completing the standard course of therapy. For most mental health concerns, 20% who start a psychological treatment fail to continue in that treatment. By comparison, the dropout rate for gambling harms is nearly double: 39%. 

We believe that dropout rate is not explained by people not wanting to put in the work to change. Instead, the relationship with the therapist and ambivalence about the progress being made tend to derail the course of treatment. Finances are also a real problem. Patients might not be able to afford their appointments, or their insurance doesnt cover a diagnosis of a gambling disorder.

Gaps in knowledge and funding

About a decade ago, a friend who is an alcohol researcher observed that the thinking and research about gambling was about four decades behind where it is for alcohol. The gaps in knowledge were evident. We still dont have good models for how a gambling problem develops, or how to conceptualize an addiction without a substance. We dont know the long-term effects of experiencing gambling problems and gambling disorder. And we dont fully understand the extent to which improvements from treatment are maintained.

While researchers around the world are chipping away at these knowledge gaps, there continue to be huge challenges not the least of which is that gambling regulations keep changing and new forms of gambling are always emerging. 

More importantly, there is little funding available to learn more about gambling disorder and almost no funding from the U.S. government. In 2022, the National Institutes of Health invested over $570 million to study alcohol use problems. 

The amount the NIH budgeted to study gambling? 

Zero.

James P. Whelan is a research professor of Clinical Health, University of Memphis

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Revenues from transactions tumbled 20%, the company said as part of its fourth-quarter earnings report on Tuesday. Fees collected fell to $39 million in the fourth quarter versus $48 million in the same quarter in the prior year.

Robinhoods overall revenue rose slightly to $380 million in the latest quarter from $363 million in the same quarter of 2021. Meanwhile, the companys losses narrowed to $166 million in the latest quarter versus $423 million in the fourth quarter of 2021.

Were now starting to see meaningful traction on a number of the products we launched, which gives us confidence they can grow into significant business lines over time, Vlad Tenev, CEO and co-founder of Robinhood, said in a statement.

Shares for the online brokerage rose 5% to $11 in after-hours trading, following the release of the earnings report.

Robinhood has recently pivoted into the cryptocurrency market, launching a crypto wallet in August 2022. The decrease in revenue from crypto transactions demonstrates the continued struggles of crypto and crypto-adjacent companies during the industrys recent bear market.

Founded by Stanford University graduates Vlad Tenev and Baiju Bhatt in 2015, Robinhood makes the bulk of its money from high-speed trading firms that pay for the right to execute stock transactions that users submit through the brokerage. 

Early in the pandemic in 2020, Robinhood saw its fortunes skyrocket as millions, especially millennials and Gen Zers, flocked to the app to trade stocks. Because of its accessibility and comparatively low fees, Robinhood also became a hotbed for the trading of memestocks, like GameStop, AMC Entertainment, and Bed Bath & Beyond. (To the memestock traders chagrin, Robinhood temporarily paused the buying and selling of these shares in response to the sudden buying frenzy.) 

Building off of its momentum in 2020, the company went public in July 2021, at $38 per share. While its share prices briefly peaked $55, it has mostly declined since the IPO, as legacy brokerages like Vanguard or TD Ameritrade pushed back on the upstart.

Just a month before Robinhood went public, the Financial Industry Regulatory Authority issued the trading platform a $70 million fine in June 2021 for service outages in March 2020. And in August 2022, the New York State Department of Financial Services fined the companys cryptocurrency division $30 million for significant violations of the Departments anti-money laundering and cybersecurity regulations, Adrienne Harris, the Departments superintendent, said in a statement.

Sam Bankman-Fried, the disgraced founder of the now bankrupt cryptocurrency exchange FTX, reportedly owns approximately 7% million of Robinhood shares. After the earnings release, CNBC reported that the board approved a buy back of his shares.

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Instead, the executive director of the Florida High School Athletic Association is recommending that most personal information revealed on medical history forms stay at the doctors office and not be stored at school.

The associations board has an emergency meeting Thursday to vote on whether to adopt the four-page form which would remove questions that force student-athletes to share details about their menstruation cycles in order to be participate in sports.

Many other states ask or order female athletes to include details about their menstruation cycles with other health information.

The Florida associations spokesperson has said the proposed changes were not in response to concerns about transgender athletes competing in womens sports, as some social media users claim.

Florida Gov. Ron DeSantis in 2021 signed a bill barring transgender girls and women from playing on public school teams intended for student athletes identified as girls at birth, which put DeSantis and the state into the national cultural debate over transgender rights.

Under the new Florida recommendation, answers to additional questions about mental health, alcohol and drug use, and family health history would stay in the offices of the health care practitioner who conducted the medical screening.

An earlier version of the form, which had mandatory questions about students menstrual histories, had been recommended by an advisory committee of the association. Committee members said making the menstrual cycle questions mandatory rather than optional was consistent with national guidelines for sports physicals developed by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Sports Medicine and other groups.

The national guidelines said menstrual history is an essential discussion for female athletes because period abnormalities could be a sign of low energy availability, pregnancy, or other gynecologic or medical conditions.

However, the earlier version of the form created concerns and questions from parents, school district administrators, school board members and coaches regarding the health privacy of student-athletes, according to the Florida association boards Thursday meeting agenda.

Therefore, this recommendation provides pertinent medical history to the qualified health care practitioner and gives schools the medical authorization necessary for allowing athletic participation, while the protecting the privacy of the student-athlete, the agenda item said.

Thursdays meeting was being held after a group of Democratic state lawmakers sent a letter this week to John Gerdes, the associations president, calling the reporting requirements in the earlier proposed form highly invasive. The letter said, no girl should be forced to disclose her bodily functions to someone who is not her mother, father, caretaker, or physician.

The state lawmakers said they were concerned that, if the schools had the information, a coach or athletic director would be able to get access to it. With the current form, such questions are optional, not mandatory; in the revised form under consideration, they would be scrapped.

There is absolutely no reason for FHSAA to collect such private information and no reason why the schools need it, the lawmakers said in the letter.

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